Only 4% of sexually active gay and bisexual men in the U.S. use Truvada as pre-exposure prophylaxis (PrEP)

The Williams Institute at UCLA School of Law finds that only 4% of sexually active gay and bisexual men in the United States use Truvada as pre-exposure prophylaxis (PrEP), which the Centers for Disease Control and Prevention regards as a highly effective tool to prevent the transmission of HIV.

In addition, researchers found that most sexually active gay and bisexual men aged 18-25 are not tested for HIV annually, as recommended by the CDC, and 25% of young men have never been tested.

“Our findings suggest that health education efforts are not adequately reaching sizable groups of men at risk for HIV infection,” said the study’s principal investigator Ilan H. Meyer, Distinguished Senior Public Policy Scholar at the Williams Institute. “It is alarming that high-risk populations of men who are sexually active with same-sex partners are not being tested or taking advantage of treatment advances to prevent the spread of HIV.”

This is the first study to report on estimates of HIV testing and use of PrEP among gay and bisexual men using a national probability sample in the United States. In the study, researchers examined gay and bisexual men in three age groups: young (18-25), middle (34-41) and older (52-59).

Key findings

PrEP Use

Only 4% of sexually active gay/bisexual men of all age groups use PrEP.

Visiting an LGBT health clinic and searching online for LGBT resources were associated with greater likelihood of PrEP use.

Slightly more than half (52%) of young sexually active gay and bisexual men were familiar with PrEP as HIV prevention, compared with 79% of men aged 34-41.

Bisexual and non-urban men were less familiar with PrEP compared with gay-identified and urban men.

Most (68%) men who were familiar with PrEP as HIV prevention had a positive attitude toward PrEP use—despite the low level of usage.

HIV Testing

One quarter (25%) of young gay and bisexual men had never tested for HIV in their lives, compared to approximately 8% of the middle and older groups of men.

45% of young sexually active gay and bisexual men had tested for HIV at least annually, compared with 59% of men aged 34-41 and 36% of those aged 52-59.

Black gay/bisexual men were more likely than White men to meet recommendations for HIV testing, which may be due to recent efforts to target Black men for HIV testing.

Visiting an LGBT health clinic and being out as gay or bisexual to health care providers were associated with greater likelihood of HIV testing.

“The extremely low rate of PrEP use, while not surprising given barriers to access in various parts of the country, is disappointing,” said lead author Phillip L. Hammack, Ph.D., Professor of Psychology at the University of California, Santa Cruz. “I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did. The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”

“In the early days of the AIDS epidemic, gay and bisexual men had to rely on LGBT community sources to receive information about HIV prevention,” said Meyer. “Our findings suggest that contact with LGBT community resources—health clinics and online information—still serves an important role in HIV prevention.”

Research reported in this article is part of the Generations Study, supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health, under award number R01HD078526. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Generations investigators are Ilan H. Meyer, Ph.D., (PI, UCLA); David M. Frost, Ph.D., (University College London); Phillip L. Hammack, Ph.D., (UCSC); Marguerita Lightfoot, Ph.D., (UCSF); Stephen T. Russell, Ph.D. (University of Texas, Austin) and Bianca D.M. Wilson, Ph.D., (UCLA) Co-Investigators are listed alphabetically.